Vertically unstable type III odontoid fractures: Case report

Andrew Jea, Claudio Tatsui, Hamad Farhat, Steven Vanni, Allan D Levi

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

OBJECTIVE AND IMPORTANCE: Type III odontoid fractures are generally thought of as unstable fractures that can be successfully treated with an external orthosis. However, there is a rare subtype of Type III odontoid fractures that is similar in the degree of instability to atlanto-occipital dislocation injuries. Not recognizing or not treating this injury urgently and aggressively could lead to devastating iatrogenic neurological injuries such as quadriplegia and fatal lower brainstem palsies. CLINICAL PRESENTATION: We present the case of a 73-year-old woman with a vertically distracted Type III odontoid fracture and associated quadriparesis and brainstem deficits. The patient was kept in a rigid collar, placed in a kinematic bed, and admitted to the trauma service for the management of her life-threatening systemic injuries. Traction was not applied. INTERVENTION: As soon as the patient was systemically stable, she was taken to the operating room for C1-C2 fixation with a screw-rod construct supplemented by cable and structural iliac crest bone graft. CONCLUSION: Delayed recognition of this subtype of Type III odontoid fracture could have fatal or highly morbid consequences, such as quadriparesis/-plegia, lower brainstem dysfunction, and ventilator-dependence, for the patient. It is important to keep a high level of suspicion for this unusual subtype of Type III odontoid fracture.

Original languageEnglish
JournalNeurosurgery
Volume58
Issue number4
DOIs
StatePublished - Apr 1 2006

Fingerprint

Quadriplegia
Wounds and Injuries
Brain Stem
Paralysis
Orthotic Devices
Traction
Operating Rooms
Mechanical Ventilators
Biomechanical Phenomena
Transplants
Bone and Bones

Keywords

  • Cervical spine fracture
  • Type III odontoid fracture
  • Unstable spine fracture

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Vertically unstable type III odontoid fractures : Case report. / Jea, Andrew; Tatsui, Claudio; Farhat, Hamad; Vanni, Steven; Levi, Allan D.

In: Neurosurgery, Vol. 58, No. 4, 01.04.2006.

Research output: Contribution to journalArticle

Jea, Andrew ; Tatsui, Claudio ; Farhat, Hamad ; Vanni, Steven ; Levi, Allan D. / Vertically unstable type III odontoid fractures : Case report. In: Neurosurgery. 2006 ; Vol. 58, No. 4.
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